I have said to people many times - your psychiatrist works for you. You pay the psychiatrist. They are your employee. That means you're the one who decides if they are hired or fired. But choosing a psychiatrist is no mean feat as someone who others consider "good" may not be "good" for you. So the only thing to do is to research and interview a doctor - just as you would any employee.

If you have bipolar disorder or another mental illness it's easy to find yourself in a pit of self-hatred. If the depression doesn't get you there, regret over what you've done when you're manic might. Self-hatred is just all too common for those of us with mental health issues. And self-hatred produces all kinds of effects - like ignoring self-care. You might find yourself not eating, not showering, not exercising, not being kind to yourself or constantly hearing a voice of hatred in your head. And the trouble with all these things is that not only are they "not good for you" they make you feel worse both in the short and the long term. Making good self-care choices is a way of fighting back.

Sex is a basic human drive. We want to eat. We want to sleep. And we want to have sex. These are the things that bring us pleasure in life. Almost everything boils down to those three things. But unfortunately, bipolar disorder and bipolar medication can affect all three. Bipolar disorder and its associated medication can make you eat. Or make you not eat. It can make you sleep. Or it can make you not sleep. And it can affect your sex life the same way. But for some reason, doctors often take the effect on your sex life least seriously.

I have been burdened with side effects since the day I took my first psychotropic medication some 13 years ago. At that time the medication I was on made it impossible for me to be awake, pretty much ever. I had no idea how much hell I was in for and my doctor didn't seem to believe me when I told him about it. So I did the responsible thing - I just kept taking the medication, hoped the treatment would work and that the side effects would go away. But that's mostly because I didn't know what I was doing. Today I know that severe side effects are something that we choose and are not something that is thrust upon us. We choose what we can live with, even tacitly, always have, always will.

I've seen quite a few doctors and I've talked to quite a few people who've seen quite a few doctors and one thing that constantly comes up - and decreases patient care - is a negative relationship between patients and doctors / psychiatrists. There are many reasons people have a poor relationship with their doctor, but one of them is that people are intimidated by their doctor. And doctors never seem to understand, or compensate, for that. So, quite simply, we have to.

One of the problems with mental illness is that it is episodic. Particularly in the beginnings of mental illness, someone will have an episode of illness, and then an episode of wellness. While I'm never against episodes of wellness, this does lead to a problem: when we're well, we convince ourselves we don't have a problem and refuse to get help. This is normal human behavior. No one wants to believe there is anything wrong with them. So it's natural to deny problems when they are not readily harming us. Unfortunately, this means that many people don't get help for a mental illness. When we're sick, we're too sick to get help. When we're well, we deny we need it.

Doctors should take every patient seriously, but they don't. How can you get your doctor to take you seriously? Lets start with this recent comment (edited for length): I have a masters degree in pharmaceutical science and have worked with clinical research for 11 years . . . I feel that maybe I get to close to be on the "same level" as my psychiatrist. . . I am afraid my doctor might think that I have better control of my bipolar "state" than I have. I do not have control . . . I want her to think of me as THE patient. But on the other hand I do want to be involved and discuss treatments etc. . . I think that she does not realize how bad I am right now. No one does. I am that happy, funny outgoing guy Johan. They just do not look behind the mask . . . It is strange that no one takes it seriously when you say you have suicidal thoughts. Mutilation . . . My doctor knows that I am depressed. But why does she not realize how bad it is? So, how do you get your doctor to take your seriously when you often appear alright to your doctor? Can your intellect actually do you a disservice?

I have trust issues, but then, I think everyone does. We all grow up with people disappointing us and breaking our trust. It's just a part of becoming an adult. But unfortunately, all relationships are based on trust, and this includes one with a doctor. It's essential to be able to trust what your doctor says and does. You have to be able to believe in what he's saying in order to try treatments that are often unpleasant and might make you feel worse before they make you feel better. But doctors do a lot of things to break that trust, sometimes because they have to and sometimes simply because they do. So how's a patient to get over broken trust in a relationship with a doctor?

Most people I know with a mental illness try very hard to get better. They look for sources of help, support and information. Most people I know don't sit around waiting for someone to save them. But then there are the people who do. There are the people who whine and complain that no one will help them and yet turn down help or refuse to look for it. There are the people who kvetch that there is no support available to them in spite of the fact that the world is drowning in helplines available 24-hours-a-day. In short, people think mental health services should be brought to them on a silver platter - and then be spoon-fed.

I love my readers for so many reasons, but one of them is that they leave intelligent and interesting comments on my posts. This one caught my eye: . . . in my experience anytime you challenge a p-doc they try to attribute it to a symptom such as paranoia or delusions of grandeur. So my question is how to talk back to a doctor when you don't agree with him if you are as knowledgeable as you obviously are without that happening or is it a lost cause? (Ever think a doctor has delusions of grandeur? Just saying...) I do not think it's a lost cause. I talk to my doctor like a colleague all the time, but it is tricky.